Effect of different implant placement depths on crestal bone levels and soft tissue behavior: A 5â year randomized clinical trial

ObjectivesThis randomized clinical trial analyzed the longâ term (5â year) crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the anterior mandibular region at different depths (equiâ and subcrestal).Materials and methodsEleven edentulous patients were randomly divided in a splitâ mouth design: 28 equicrestal implants (G1) and 27 subcrestal (1â 3 mm) implants (G2). Five implants were placed per patient. All implants were immediately loaded. Standardized intraoral radiographs were used to evaluate crestal bone (CB) changes. Patients were assessed immediately, 4, 8, and 60 months after implant placement. The correlation between vertical mucosal thickness (VMT) and soft tissue recession was analyzed. Subâ group analysis was also performed to evaluate the correlation between VMT and CB loss. Rankâ based ANOVA was used for comparison between groups (α = .05).ResultsFiftyâ five implants (G1 = 28 and G2 = 27) were assessed. Implant and prosthetic survival rate were 100%. Subcrestal positioning resulted in less CB loss (â 0.80 mm) when compared to equicrestal position (â 0.99 mm), although the difference was not statistically significant (p > .05). Significant CB loss was found within the G1 and G2 groups at two different measurement times (T4 and T60) (p  .05).ConclusionsThere was no statistically significant difference in CB changes between subcrestal and equicrestal implant positioning; however, subcrestal position resulted in higher bone levels. Neither mucosal recession nor vertical mucosa thickness was influenced by different implant placement depths.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154286/1/clr13569.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154286/2/clr13569_am.pd

Traps of multi-level governance. Lessons from the implementation of the Water Framework Directive in Italy

During recent decades, different patterns of multi-level governance (MLG) have spread across Europe as a consequence of Europeanisation of public policies, which have increasingly adopted decentralized and participatory procedures conceived as a tool of more effective and accountable policy-making. It appears, however, that the implementation of operational designs based on MLG may be rather problematic and it does not necessarily bring to the expected performance improvements. Referring to the case of the EU Water Framework Directive (2000/60/EC), which conceives the creation of new multi-level institutional settings as a key tool for enacting a new holistic approach to water management and protection, this article explores the difficulties that the implementation of such settings has brought in Italy, despite some favorable pre-conditions existing in the country. Evidence is provided that along with institutional and agency variables, the implementation effectiveness of MLG arrangements promoted by the EU can be challenged by their inherent characteristics